Deborah K. Unversaw, RN, MBA, CCM, UR-CERTIFIED

RN License #28113758A

**** *. ************ ****

Bloomington, IN 47408

812-***-****

Vision: I am looking for a company to provide my vast nursing experience and enhance my

continuing education. I enjoy challenges and helping to expand healthcare in its every evolving

dynamic structure.

QUALIFICATIONS

41 years as a Licensed Nurse

Certified Case Manager (Case Manager’s Society of America)

8 years Acute Care Utilization/Case Management

20 years in the Insurance Industry doing Utilization Review/Case Management

Implemented 3 Utilization/Case Management programs, acute settings

Implemented and Managed an Internal Medicine Physician Office and Family Practice

Work compensation and Mental Health /Substance Abuse UR/Case Management

WORK HISTORY

August 2,2021 to Current: PayerCompass, RN Case Manager.

UM/CM for TPA’s.

Trainer for new employees at 10 months of employment.

Clinical Assessment of policies and procedures at 8 months of employment.

Jan 16, 2018 to April 2021: Anthem Blue Cross, RN National Commercial Accounts Case Manager/SR

Case Management, Disease Management, Complex Case Management

Feb 25, 2019, IHM-FedEx: National IHM Atlanta

July 7, 2014 to January 1, 2018: SIHO Insurance Services, RN Case Manager/

RN Utilization Review Nurse for TPA accounts with >35,000 lives

2017 CASE MANAGER FOR THE TEAMSTERS ACCOUNT > 3000 LIVES

Preceptor for new employees

RN Medical Management for TPA accounts

WC City of Bloomington 700 lives

Psych Medical Management

Monthly Reports

Continuing Education

December 12, 2011 to June 30,2014: Dr. Kristina Morris, Family Eye Care, Billing and Insurance Specialist

All aspects of physician billing and insurance coordination for Office Visits

Daily Chart Audits

Monthly billing and Collections

Credentialing

Compulink Resource for the office (EHR)

June 2011 to December 28, 2011: IU Health Southern Indiana Physicians, Clinical Coordinator

Staff Scheduling

Ordering Supplies

Staff Training

Electronic Health Record Training

October 2010-July 2011: Indiana University School of Optometry, Bloomington, Billing Support Clerk

Filing of claims with Anthem, Medicare, and Medicaid

Customer Service Calls and Problem solving

Collected from Anthem with re-billing corrections thousands of dollars

Temporary/Hourly position

November 2009 to September 2010:Visiting Nurse Service, Morgan County Branch, RN Case Manager

Home health care that involves teaching, PICC line care, IV care, wound care, wound vacs and disease management for teens through Senior’s.

Traveling over 5 counties, over 2,000 miles per month.

September 2007-November 2009:Golden Living Long Term Care Healthcare Center, Director of Clinical

Education and Staff Development/MDS Coordinator

Aspects of job included duties in Human Resource development and clinical

education for the staff as Director of Clinical Education.

Training of CNAs for Electronic Medical Records

Nursing assessments for Medicaid and Medicare per MDS standards for billing

Purposes and care planning the individual resident’s needs.

Successful survey team member. Represented Education and Staff Development

Helped gain 2 x reimbursements as MDS coordinator for Medicare and Medicaid

Patient’s.

Successful State Board of Health Survey

Successful Chart Audits by State Board while under MDS Coordinator position

Instructor for CPR/AED/First Aid and clinical education for staff

April 2007-September 2007: Monroe Family Practice, RN Practice Manager

Started the Monroe Family Practice with two physicians. All aspects of office

management responsibility and start up including physician recruitment.

Position was dissolved when several contracted physicians decided not to re-locate

to Bloomington, IN.

Cared for all age groups in this family practice

September 2006-April 2007:Monroe Hospital, Director of Utilization Review Coordinator/Case Manager

Started the UR/CM program for the new hospital in Bloomington, IN

Set up policies and did insurance review as well as quality indicators for quality

management and financial reports.

Also was the Interim Director of the Medical Surgical Unit and developed and

opened the Progressive care unit.

July 2001-September 2006: Bloomington Hospital and Healthcare System, Staff/Charge Nurse

Critical Care Unit/Cardiovascular Recovery Unit

Helped originate the Cath Lab pre/post op area on 3 NW.

October 1997-July 2001: Morgan County Memorial Hospital, Director of Utilization/Case Management

Department.

Implemented and designed Utilization/Case Management Program at MCMH.

Instituted Clinical pathways for Medical/Nursing Staff, a designee on the Clinical

Performance Improvement Committee and instituted the Multi-disciplinary

Committee.

Infection Control Surveillance Officer and Mortality Review

Coordinator, Employee health and Infection control officer as needed.

Assisted with Social Service duties when needed and helped with Joint Commission

Survey.

Jan.1995-October 1997: Anthem Health of Indiana, Disease State Management Coordinator for Asthma

Developed and implemented the Asthma case management program for the state of

Indiana for Anthem Health for infant through senior’s age groups.

1995-1996: Heritage Indiana Medical Group, Director of Utilization/Case Management Department.

Implemented case management department and managed seven employees. Case

Management department savings of $200,000-500,000 per month. Budget and Strategic planning for the department

May 1995: Odyssey Health Consultants, RN Consultant, Development of a Managed Services

Organization in Johannesburg, South Africa

Speaker for the first meeting of The Case Manager Society of South Africa.

Instituted Case Management department in Johannesburg, SA

1994-1995: Hospice of Indianapolis, Provider Relations Coordinator

Interacted and influenced the referral patterns of healthcare professionals in

Hospitals, home health agencies, nursing homes and private practice of physicians.

Developed the Hospice program for several counties in Eastern Indiana.

1993-1994: Dialysis Institute of Indiana, Staff/Charge Nurse

Opened and managed a new facility at Northwest Indianapolis for dialysis patients. Charge

Nurse of 32 patients per 2 shifts and 11 technicians.

1992-1993: Sagamore Health Network, Utilization Review Coordinator

Utilization and case management coordination of psychiatric and medical patients.

1980-1986: 1990-1992: Wishard Memorial Hospital, Staff/Charge Nurse

Emergency Room. Level One Trauma Center. Also started out in the

Medical/Surgical Unit (1980-1982) that received many patients from the SICU

(1982-1985) Post Anesthesia Care Unit, Staff Nurse.

EDUCATION

*LNC, Legal Nurse Consultant certificate-2018

*MBA, Indiana Wesleyan University, December 1998

* BSN, Indiana Wesleyan University, May 1994

* ASN, Indiana University, May 1991

*LPN, Indiana Vocational Technical College, August 1981

CERTIFICATIONS

*CCM, # 4217766 December 2, 2015- November 30, 2020

*Certification for Care Guidelines Specialist April 18, 2016- April 18, 2018 (Milliman Guidelines)

*CPUR-1998 Certified Professional in Utilization Review

*CPR/First Aid/ AED Certified

*Instructor for CPR/First Aid/AED

*TB certified

*IV certified

ORGANIZATIONS/ASSOCIATIONS

*American Association of Legal Nurse Consultants

*Ellettsville Mini 4-H, Co-Leader, 2007-2010

*American Nurses Association

*Member of American Association of Managed Care Nurses

*Unionville Hot-shots, Co-Leader for 4-H group

*Parent Volunteer for the Tri-North PTO

*Parent Volunteer for the Tri-North Athletics

*Community Service Leader for Benton Township Auditor Office

*Volunteer Parent for Bloomington North Athletics

*Sport-fishing Co-Leader for 4-H, Sept 2017-

EHR SYSTEMS

Allscripts, McKesson, Compulink, New Crop, OAO, HSP, AS 400, Web-based programming, Avedon

Licensure

Indiana-compact.

Florida

Ohio

North Carolina

Kentucky

California

Texas

Illinois

VR

NY

TN

Wisconsin

Pennsylvania

Georgia

AK

NM

DC

DE

Maine

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